Bloodletting, Bone Brushes, and Tooth Keys: White-Knuckle Adventures in Early Dentistry

September 3rd, 2014

dental-extraction-edited

With all those gleaming, stainless-steel tools readied for painful prodding, few people look forward to visiting the dentist. But modern dentistry is a walk in the park compared with archaic methods of treating oral maladies: Be glad you’re not seeking treatment for mysterious “tooth worms” or using dentures filled with the syphilitic teeth of dead soldiers.

“By the time Washington was elected president, he only had one natural tooth remaining in his mouth.”

“Dentistry, as we understand it today, didn’t emerge as a licensed profession until the end of the 19th century, although practitioners had been calling themselves dentists since the late 1700s,” says Dr. Lindsey Fitzharris, who studies the history of science, medicine, and technology, and is the creator of The Chirurgeon’s Apprentice. Before dentistry became its own field, tooth-related issues were handled by any ordinary doctor, though little was understood about oral health and the reasons teeth might decay.

The important role of healthy teeth wasn’t lost on the ancients: Since at least 3000 B.C., people in the Mesopotamian region used the frayed ends of fibrous twigs or chew sticks, also known as miswak or siwak sticks, to clean their teeth. “Different cultures have used twigs from trees and shrubs with wood grain that is very intertwined,” says Scott Swank, a dentist, historian, and curator of the National Museum of Dentistry. “You peel the bark off and chew it to get the fibers to fray out, and then you use those frayed fibers to clean your teeth. They’re still used today in some parts of Africa and the Middle East.”

Top: Various dental extraction methods from J.M. Bourgery's "Complete Treatise of Human Anatomy," circa 1870. Above: Toothbrushes at the National Museum of Dentistry include, from left to right: A miswak or chew stick, an early 20th century celluloid toothbrush by Taub, a rubber-tipped gum stimulator and toothbrush from pre-1945, a Strockway rotary toothbrush from the 1950s, a Dr. Mayland's rubber toothbrush from the 1920s, a 1930s Rotor toothbrush, and another chew stick.

Top: Various dental extraction methods from J.M. Bourgery’s “Complete Treatise of Human Anatomy,” circa 1870. Above: Toothbrushes at the National Museum of Dentistry include, from left to right: A miswak or chew stick, an early 20th century celluloid toothbrush by Taub, a rubber-tipped gum stimulator and toothbrush from pre-1945, a Strockway rotary toothbrush from the 1950s, a Dr. Mayland’s rubber toothbrush from the 1920s, a 1930s Rotor toothbrush, and another chew stick.

Swank says the toothbrush design familiar to most Americans dates to the late 1490s in China. “The Chinese took wild hog bristles and attached them to bamboo handles,” explains Swank, “which evolved into bone handles. Bone was used right up to the early plastics, but boar’s hairs are hollow, so there’s no way to get bacteria out of these things—not bacteria from their hair, but bacteria that was already in your mouth.” While a boar’s hair toothbrush might remove some food particles, it could also distribute bacteria, thus causing problems like gingivitis, an inflammatory gum disease.

The modern, mass-produced toothbrush was invented in 1780 by William Addis, while he was languishing in an England jail for inciting a riot. At the time, most Europeans used a cloth to apply a gritty substance like salt, ground eggshells, chalk, or crushed charcoal to clean their teeth. Supposedly inspired by an ordinary broom, Addis carved holes into one end of an animal bone left over from one of his meals, into which he inserted knotted boar bristles. While Addis’ design was novel, the boar bristles were still susceptible to bacterial growth.

An advertisement and selection of bone-handled toothbrushes made by Addis' company (eventually renamed Wisdom Toothbrushes), mid-19th century.

An advertisement and selection of bone-handled toothbrushes made by Addis’ company (eventually renamed Wisdom Toothbrushes), mid-19th century.

That disconnect is indicative of the poor understanding people had about the relationship between tooth care, diet, and dental health. “Many people in the past believed ‘tooth worms’ were the cause of tooth decay—tiny creatures that would bore holes in people’s teeth,” explains Fitzharris. Records indicate that the fear of tooth worms goes back at least to the time of the Sumerians, or around 5,000 years ago.

Depending on the severity of a patient’s pain, healers might offer a variety of unfortunate tooth-worm treatments. “Often, practitioners would try to smoke the worm out by heating a mixture of beeswax and henbane seed on a piece of iron and directing the fumes into the cavity with a funnel,” Fitzharris says. “Afterwards, the hole was filled with powdered henbane seed and gum mastic, which may have provided temporary relief given the fact that henbane is a mild narcotic. Many times, though, the achy tooth had to be removed altogether. Some tooth-pullers mistook nerves for tooth worms, and extracted both the tooth and the nerve in what was certainly an extremely painful procedure in a period before anesthetics.”

Over the next few millennia, several advancements were made towards alleviating the symptoms of dental-health problems. The Etruscans invented dental bridges; the Romans created gold crowns and artificial teeth made from bone, ivory, or wood; the Chinese developed amalgam, a mixture of silver, tin, and mercury used for fillings.

This early 20th-century copy of an ancient Roman bridge shows how false teeth were secured with metal loops. © Wellcome Library, London.

This early 20th-century copy of an ancient Roman bridge shows how false teeth were secured with metal loops. © Wellcome Library, London.

In medieval Europe, however, such advancements were rarely applied. During the Middle Ages, most doctors did research and prescribed treatment, restricting themselves to the detached realm of academia, while medical procedures like surgery were handled by a local barber-surgeon. “Until the early 19th century, barber-surgeons performed a variety of services,” explains Fitzharris. “They lanced abscesses, set bone fractures, picked lice from hair, and even pulled rotten teeth. The tradition of the striped barber’s pole harks back to that era, when it served as an advertisement for their proficiency as bloodletters.”

“Dentures were often referred to as ‘Waterloo Teeth’ after those ripped from the bodies of dead soldiers.”

The use of bloodletting as a cure-all stemmed from the ancient belief that sickness was caused by an imbalance of the four humors or bodily fluids (black bile, yellow bile, blood, and phlegm). Though it was practiced up through the early 20th century, bloodletting almost always made patients sicker. The familiar red-and-white striped barber pole originally represented the bloodied cloth bandages that would twist in the wind as they were hung out to dry. To advertise their dental skills, barber-surgeons also hung rows of rotten teeth outside their shops.

This ivory tooth sculpture from the mid-18th century called "The Tooth Worm as Hell’s Demon" opens to reveal the painful and demonic tooth worms at work. Via the Chirurgeon's Apprentice.

This ivory tooth sculpture from the mid-18th century called “The Tooth Worm as Hell’s Demon” opens to reveal the painful and demonic tooth worms at work. Via the Chirurgeon’s Apprentice.

It wasn’t until the 18th century that the science of modern dentistry began to take form. During this period, global exploration and trade led to major changes in the Western diet, particularly as sugar became more accessible and no longer a luxury product. Along with increasing lifespans, such dietary shifts led to greater dental problems, and doctors worked to find new ways of treating problematic teeth. But the methods themselves were often excruciatingly painful.

“The tooth key was first mentioned in Alexander Monro’s Medical Essays and Observations in 1742,” says Fitzharris. “The claw was placed over the top of the decaying tooth; the bolster, or the long metal rod, was placed against the root. The key was then turned and, if all went well, the tooth would pop out of the socket. Unfortunately, this didn’t always go according to plan.” In many cases, the patient’s tooth shattered as the device was turned, and each piece had to be individually pulled from their bleeding gums.

An illustration of dental keys for tooth extraction from Savigny's catalog of surgery implements, circa 1798.

An illustration of dental keys for tooth extraction from Savigny’s catalog of surgery implements, circa 1798.

Around the same time, European surgeons began experimenting with implanting teeth. Patients who could afford the procedure chose between living or dead teeth—a classification that depended on the state of the human body the teeth were removed from. Dead teeth might have been removed from a previous patient or a body at the local morgue, while a live tooth would be selected from the mouth of a living donor, typically a poor person or slave whose desirable tooth was forcibly extracted without compensation. The replacement would then be fixed into the empty socket using silver wire or silk ligatures.

Scientific knowledge about dental health advanced rapidly during the 18th century, particularly through the research of Pierre Fauchard, referred to as the father of modern dentistry. “Fauchard posited that tooth decay was linked to sugar consumption and not little creatures burrowing inside the tooth,” Fitzharris says. In 1728, Fauchard published his famous text, “Le chirurgien dentiste” or “The Surgeon Dentist,” the first complete book on dental science and treatment. But across the pond, Americans were still a bit behind the times when it came to dentistry. Indeed, our first president had severe dental health issues.

Diagrams from Fauchard's 1728 book on dentistry showing methods of tooth restoration (left) and a dental drill (right).

Diagrams from Fauchard’s 1728 book on dentistry showing methods of tooth restoration (left) and a dental drill (right).

George Washington’s personal records indicate that he bought toothbrushes and dentifrice, or tooth-cleaning substances, but to no avail. A former curator at the National Museum of Dentistry studied Washington’s oral-health problems and suggests they were the result of a common medicine used during Washington’s lifetime. “Mercurous chloride, also called calomel, was a brand new medical treatment, but they didn’t have the FDA to regulate medicines like we do,” says Swank. “They used calomel as a purgative and a cathartic (for its laxative effect), to treat malaria, and for yellow fever in Philadelphia during the late 1700s. Nobody knew what the long-term effects would be, but apparently because of the amount of mercury in it, calomel just devastated teeth.”

A detail of Rembrandt Peale's first portrait of George Washington reveals a discolored scar along his left cheek likely caused by dental issues.

A detail of Rembrandt Peale’s first portrait of George Washington reveals a discolored scar along his left cheek likely caused by dental issues.

By the time Washington was elected president at age 57, he only had one natural tooth remaining in his mouth. “During the presidency, he lost that one, too,” says Swank. “His second inaugural address was the shortest in history—I think it’s only a couple of paragraphs long—and some people close to Washington wrote about him having fits with his teeth.” The wider public didn’t know about Washington’s dental problems because he wore dentures most of the time, and his presidential portraits generally project an image of a healthy president, glossing over his dental drama. “But if you look closely at Washington’s portrait by Rembrandt Peale,” says Swank, “there’s a scar on Washington’s face that some believe was due to an infected tooth.”

The National Museum of Dentistry’s collection includes one of Washington’s lower dentures, which came from Washington’s favorite dentist, Dr. John Greenwood, who kept the president’s older pairs whenever he was fitted for a new set. “We have a lower denture, Mount Vernon has an upper and a lower, the New York Academy of Medicine has a lower, and half a denture is owned by the Royal London Hospital Archives and Museum,” says Swank. Washington’s denture at the National Museum is made of ivory, likely from a hippopotamus tusk. Other dentures that belonged to Washington included human teeth, a common practice at the time. “Greenwood had a whole box of human teeth,” says Swank. “I think for every tooth he extracted out of somebody, if it was in good enough shape and he could use it in a denture, he kept it.”

Left, this lower set of Washington's ivory dentures included a hole for his last remaining tooth. Via the New York Academy of Medicine. Right, this complete set of Washington dentures was made from animal and human teeth, ivory, and lead. Via the Mount Vernon Estate.

Left, this lower set of Washington’s ivory dentures included a hole for his last remaining tooth. Via the New York Academy of Medicine. Right, this complete set of Washington dentures was made from animal and human teeth, ivory, and lead. Via the Mount Vernon Estate.

By the mid-19th century, dentures were often referred to as “Waterloo Teeth,” after those surreptitiously ripped from the bodies of dead soldiers following the Battle of Waterloo in 1815. These high-quality specimens taken from the mouths of formerly healthy young men were actually an improvement over the typical replacement teeth used by dentists, which often came with noticeable wear, staining, or bacterial infections (though it was unlikely these would be passed on to their new owner). While publicly frowned upon, stealing teeth from dead soldiers continued throughout the Crimean War and the American Civil War. Eventually, human teeth were replaced by porcelain, vulcanite, and other materials as manufacturing processes improved their strength and longevity.

At the same time, the movement to professionalize dentistry in the United States was steadily gaining ground. During the 1830s, two professors at the University of Maryland Medical School named Chapin Harris and Horace Hayden attempted to convince the administration to make dentistry its own department within the university. “Dentists at that time were being trained in other dentists’ offices, getting hands-on work right there,” says Swank. “At the time, there was no parallel in dentistry with the large medical clinics and hospitals. Practices were private, and the vast majority were single-person practices. There were no dental clinics—it was just unheard of.”

An upper set of dentures made from human teeth set into a carved ivory base, circa 1850-1870. Via Canada's <a href="http://museumofhealthcare.wordpress.com/2012/02/03/collections-corner-waterloo-teeth/">Museum of Healthcare</a>.

An upper set of dentures made from human teeth set into a carved ivory base, circa 1850-1870. Via Canada’s Museum of Healthcare.

There was also no preventive dentistry at the time, meaning no teeth cleanings, X-rays, or yearly checkups. Though toothbrushes existed, few used them regularly, and little was understood about what substances were good for strengthening enamel and preventing cavities. “That wasn’t even a concept at that time,” says Swank. “Toothbrushes and dentifrice—pastes, powders, or anything you use to clean your teeth—those types of things existed. In fact, I think the first U.S. reference to a silk thread being used to clean between the teeth where a brush can’t reach was in 1815, but nobody really did anything with it for a long time.

“Dentists, especially back then, were inveterate tinkerers,” Swank adds. “I think the type of person that went into dentistry instead of medicine did so because they enjoyed working with their hands. We’ve got any number of things invented by dentists that don’t have a worldly thing to do with dentistry.” One of Swank’s favorite items in the National Museum’s collection is a small portable device used for pulling teeth from the mid-19th century. “It is basically the Swiss army knife of tooth extraction,” he says. “If somebody needed a tooth extraction, you could just take it out of your pocket, pick whichever tool you wanted, and work on somebody. That’s just amazing to me—it’s portable tooth extraction.”

An 1827 engraving by Louis Leopold Boilly, entitled "The Steel Balm."

An 1827 engraving by Louis Leopold Boilly, entitled “The Steel Balm.”

After the university declined their request, Harris and Hayden petitioned the Maryland General Assembly to found a dental school. When it opened in 1840, the Baltimore College of Dental Surgery became the world’s first school devoted to dentistry, and today it also houses the Smithsonian-affiliated National Museum of Dentistry. Washington’s false teeth aren’t the only celebrity artifacts in the museum’s collection: They also have a set of dental tools known as “scalers” that belonged to Queen Victoria. “When you go to the dentist and the hygienist scrapes all that hard stuff off your teeth, that’s what scalers are used for,” explains Swank. “But in Victorian society, if you had enough money for them, you took your own set to the dentist instead of using the dentist’s. It was a status symbol, even though most sets were fairly plain with ivory or bone handles. Victoria’s set of dental scalers were awfully fancy—they’ve got mother-of-pearl handles and their fittings are gilded silver.”

Besides following her own dental-hygiene regimen, Queen Victoria also helped popularize anesthetics after she opted to use chloroform for the delivery of her eighth child in 1853. Soon after, other scientific improvements helped propel the field of dentistry from a niche to a mainstream profession. “In the 1890s, W.D. Miller took Fauchard’s ideas a step further,” says Fitzharris, “and discovered through a series of experiments that bacteria living inside the mouth produced acids that dissolved tooth enamel when in the presence of fermentable carbohydrates. This forever changed how dentists understood tooth decay.”

This set of dental scalers was designed for Prince Albert in the 1840s, and matches Queen Victoria's set with mother-of-pearl handles and gold fittings.

This set of dental scalers was designed for Prince Albert in the 1840s, and matches Queen Victoria’s set with mother-of-pearl handles and gold fittings.

The first real push for universal oral hygiene came after World War I, when many men were left with a condition known as Trench Mouth. Due to the absence of preventive oral care, combined with an unhealthy diet and extreme stress, many soldiers developed this severe form of gingivitis. The disastrous results led the U.S. military to update its regulations for oral health and begin advocating for better daily care. “The old military regulations on teeth went back at least to the Civil War,” says Swank. “In order to be accepted for service, you had to have three opposing teeth on the upper and the lower jaw because you had to be able to tear open a paper cartridge of gunpowder. But by the time World War II started, recruits were actually trained in oral hygiene. Of course, the guys brought those habits back home after the war.”

Dental-care products also benefitted from the wartime industrial boom, leading to the type of oral hygiene and dentistry we recognize today. DuPont developed the first toothbrush with Nylon bristles in 1938, and Wisdom Toothbrushes (the British company started by inventor William Addis) switched to synthetic materials during the wartime rationing of the 1940s.

“After the war, the standard of living increased and the middle class had a bit more disposable income,” says Swank, “and people wanted to emulate the folks they saw on movie and TV screens. That’s really when oral hygiene took off.” Crest launched its ubiquitous fluoride toothpaste in 1955, and dental professionals continued to focus more on preventive procedures rather than corrective, leading to the modern world of cosmetic dentistry and semi-annual checkups.

So the next time you’re dreading an easy-breezy tooth cleaning, remember the many patients who came before you, and be thankful you aren’t required to do a little unanesthetized bloodletting first.

A 1945 educational film on oral hygiene made by the U.S. military.

A 1945 educational film on oral hygiene made by the U.S. military.


Leave a Comment or Ask a Question

If you want to identify an item, try posting it in our Show & Tell gallery.